Clinical Implications of Thrombocytopenia at Cardiogenic Shock Presentation: Data from a Multicenter Registry

Abstract

Purpose: Thrombocytopenia (platelet count <150×10³/μL) is associated with poor outcomes in various critical illness settings. However, the prognostic value of platelet count in patients with cardiogenic shock (CS) remains unclear.

Materials and methods: We enrolled 1202 patients between January 2014 and December 2018 from a multicenter retrospective-prospective cohort registry of CS. Clinical characteristics and treatment outcomes were compared between the patients with and without thrombocytopenia.

Results: At presentation with CS, 244 (20.3%) patients had thrombocytopenia. The patients with thrombocytopenia had lower blood pressure, hemoglobin level, and worse liver and renal functions compared to the patients without. During hospitalization, the patients with thrombocytopenia had more frequent gastrointestinal bleeding (10.5% vs. 3.8%, p=0.009), sepsis (8.3% vs. 2.6%, p=0.013), requirement of renal replacement therapy (36.5% vs. 18.9%, p<0.001), requirement of mechanical ventilation (65.2% vs. 54.4%, p=0.003), longer intensive care unit stay (8 days vs. 4 days, p<0.001), and thirty-day mortality (40.2% vs. 28.5%, p<0.001) compared to those without. In addition, the platelet count was an independent predictor of 30-day mortality (per 103/μL decrease; adjusted hazard ratio: 1.002, 95% confidence interval: 1.000-1.003, p=0.021).

Conclusion: Thrombocytopenia at CS presentation was associated with worse clinical findings, higher frequencies of complications, and longer stay at the intensive care unit. Also, thrombocytopenia was independently associated with increased 30-day mortality. (Clinical trial registration No. NCT02985008).

Keywords: Cardiogenic shock; mortality; platelet; prognosis; thrombocytopenia.

Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

© Copyright: Yonsei University College of Medicine 2020.

Figures

Fig. 1. Flowchart of the study. F/U, follow-up.

Fig. 2. Cumulative survival of the participants according to the presence or absence of thrombocytopenia. Cumulative survival was estimated using the Kaplan-Meier method, and compared by the log-rank test.

Fig. 3. Non-linear relationship between the platelet count and 30-day mortality. Restricted cubic spline plot shows hazard ratios with 95% confidence intervals for 30-day mortality according to the platelet count. The plot was fitted with Cox proportional hazards model, adjusting for age, sex, body mass index, current smoking, hypertension, diabetes, history of coronary artery occlusive disease, history of cerebrovascular accident, systolic blood pressure, left ventricular ejection fraction 5 mmol/L, vasoactive inotropic score, the need for mechanical circulatory support, and the need for mechanical ventilation.

Fig. 4. Risk of all-cause mortality at 30 days for every 103/µL decrease of platelet count in each subgroup. The results were adjusted for age, sex, body mass index, current smoking, hypertension, diabetes, history of coronary artery occlusive disease, history of cerebrovascular accident, systolic blood pressure, LV ejection fraction